Borrowing from the Managed Care "Toolkit" to Increase Efficiency in Public Hospitals

Phua Kai Lit, PhD
Community Medicine Section
International Medical University
Sesama Centre
Plaza Komanwel, Bukit Jalil
57000 Kuala Lumpur

Although the concept of managed care is controversial, the number of Managed Care Organisations (MCOs) is steadily increasing in Malaysia. At the present moment, there are more than 30 Malaysian MCOs. This presentation will not deal with managed care per se but with innovations arising from the managed care movement that are potentially useful tools for increasing productivity and efficiency in public hospitals.

These tools include demand side as well as supply side interventions. Demand side tools are designed to change the behaviour of patients ("health consumers") while supply side interventions are designed to change the behaviour of doctors and hospitals ("health providers").

Demand side tools include health promotion, self-care, increased consumer cost-sharing and case management while supply side tools include clinical practice guidelines, controls on acquisition and use of expensive technology, formularies and generic drugs, utilization review, medical practice profiling, second opinions, increased use of non-clinician providers, teleconsultations and so on. The challenges of adopting and using these tools in public hospitals in Malaysia will be discussed. Ultimately, of course, much depends on whether incentives to increase efficiency are adequate and whether Ministry of Health guidelines are sufficiently flexible to permit innovation at the level of the individual hospital.

Keywords: Managed Care Organisations (MCOs), efficiency in public hospitals, demand side tools, supply side tools